夏海峰 黄海涛

【摘要】 目的：探讨右侧3a组淋巴结转移特点，分析其对非小细胞肺癌手术切除的影响。方法：通过回顾性分析2015年6月—2023年1月于苏州大学附属第一医院胸外科及苏州大学附属第四医院胸心大血管外科行右侧肺癌手术切除及系统性淋巴结清扫术共180例患者，术后病理均为非小细胞肺癌。归纳患者的各项临床资料及淋巴结转移特点。结果：3a组淋巴结阳性率为11.67％。单因素分析表明3a组淋巴结阳性组在病灶直径、病灶位置（右上叶）占比与阴性组相比均较高，差异均有统计学意义（P<0.05）。多因素分析表明病灶直径，病灶位置（右上叶）为3a组淋巴结发生转移的独立危险因素。受试者操作特征（ROC）曲线分析对病灶直径进行分析显示2.5 cm为临界值。当病灶直径>2.5 cm，3a组淋巴结转移率明显升高（P=0.001）。结论：右侧3a组淋巴结转移率也值得关注，手术过程中也应重视给予清扫。当病灶直径>2.5 cm位于右上叶的非小细胞肺癌，则更应重视3a组淋巴结切除。

【关键词】 3a组淋巴结 转移 非小细胞肺癌

Characteristics of Lymph Node Metastasis in Right Group 3a and Its Effect on Surgical Resection of Non-small Cell Lung Cancer/XIA Haifeng， HUANG Haitao. //Medical Innovation of China， 2024， 21（15）： -119

[Abstract] Objective： To explore the characteristics of right group 3a lymph node metastasis and its effect on surgical dissection on non-small cell lung cancer. Method： A total of 180 patients who underwent surgical resection of right side lung cancer and systemic lymph node dissection in the Department of Thoracic Surgery， the First Affiliated Hospital of Soochow University and the Department of Cardiothoracic Vascular Surgery， the Fourth Affiliated Hospital of Soochow University from June 2015 to January 2023 were retrospectively analyzed， and the postoperative pathology was non-small cell lung cancer. The clinical data and lymph node metastasis characteristics of the patients were summarized. Result： The positive rate of 3a group lymph nodes was 11.67%. Univariate analysis showed that proportions in lesion diameter， lesion location （upper right lobe） in the 3a group lymph node positive group were higher than those in negative group， the differences were statistically significant （P<0.05）. Multivariate analysis showed that the diameter and lesion location （upper right lobe） were independent risk factors for 3a group lymph node metastasis. Receiver operator characteristic （ROC） curve analysis showed that 2.5 cm was the critical value. When the diameter of the lesion >2.5 cm， the 3a lymph node metastasis rate was significantly increased （P=0.001）. Conclusion： The rate of right 3a lymph node metastasis is not low， and dissection should also be emphasized during the operation. For non-small cell lung cancer with a tumor diameter >2.5 cm located in the upper right lobe， more attention should be paid to 3a group lymph resection.

[Key words] 3a group lymph node Metastasis Non-small cell lung cancer

First-author's address： Department of Cardiothoracic Vascular Surgery， the Fourth Affiliated Hospital of Soochow University， Suzhou 215006， China

doi：10.3969/j.issn.1674-4985.2024.15.027

肺癌发病率和死亡率均居恶性肿瘤首位，肺癌包括非小细胞肺癌和小细胞肺癌，其中以非小细胞肺癌占大多数，淋巴转移为非小细胞肺癌发生转移的主要方式之一[1-3]。目前Ⅰ～ⅢA期非小细胞肺癌标准手术方式为肺叶切除加系统性淋巴结清扫[4]。纵隔淋巴结清扫对肺癌的分期、术后辅助治疗及预后有重要意义[5]，目前国际指南推荐纵隔淋巴结切除应至少3组，需包括隆突下淋巴结[6]。然而关于纵隔淋巴结的切除范围仍存在争论，对于右侧非小细胞肺癌，2、4、7、8及9组淋巴结常被切除，但3a组淋巴结（气管与上腔静脉、无名静脉之间的淋巴结）切除在日常临床手术实践中常被忽略。因此……